建国以来，由于贯彻党的中医政策，多数中医同道参加了国家医疗、教学、科研工作，中西医接触频繁。但在中西学术尚未沟通之前，除应注意加强团结、互相学习、取长补短外，在临证会诊之际，仍应根据中医理论，四诊八纲，辨证论治，方能获效。切忌囿于西医病名，限制中医的辨证思路，使无所措手足}或按西医诊断投药，进退无据。须知祖国医学在其漫长的发展长河中，对疾病的认识积累了丰富的经验，形成自己独特的病名。早在《内经》中就有「风」、「痹」、「痿」，「疟」、「血枯」、「鼓胀」、「消」，「瘅」等病名。迨至《金匮要略》更以病名命篇，为临床识病辨证相结合之规范。后世递相发展，形成一套辨病辨证相结合的理论体系。徐灵胎曾有「凡病之总者谓之病，而一病必有数证」之论。根据前贤教诲，结合个人体会，我认为辨病是以明病之类，辨证乃可求病之因。以病名为纲，则症候为目，而病因为本，辨病辨证相结合，则纲举而目张矣。实质上，辨证论治四字，即已概括了识病、辨证、求因、施治、理、法、方、药诸方面的问题。而非中医学无有病名，但较之近代，其统一性尚欠完整耳。
尝治一妇，乳中结核累然，乳头时渗清水，两乳发胀，胸胁胀满掣痛，经期尤甚，诊其脉象沉弦，舌苔薄白。西医诊为「乳腺副腺增生症」。一医以其炎症从火，予以清热解毒之剂。药后更觉胸闷不舒，脘痞纳杲，遂转求余治。盖乳头属足厥阴，乳房属足阳明。当其五七之年，阳明脉衰，兼之忧思恚怒，肝失条达，而致盱木侮土，气血痰湿胶结不化，致成「乳癖」之病。其因在于气滞，证属肝脾不和。遵「木郁达之」之旨，予舒肝健脾，解郁通络之治。用醋柴胡、青蒿、橘叶、丹皮、栀子、当归、白朮、薄荷、王不留行、路路通、生草，凡五诊，月余而平。
有些病证，中西医病名不同，然其临证表现有的相似，虽可借鉴，但其认识亦有差异，不可混为一谈。「甲状腺肿大」，虽类似中医之「瘗瘤」，但情况又各不相同。而「甲亢」一证，则与「气瘿」近似，多为本虚标实之候。本虚者，气阴两虚』标实者，胃热肝郁或化火生风。初则宜清肝泄热，佐以养阴清胃，以龙胆泻肝汤、丹栀逍遥散化裁之，或酌投白虎、竹叶石膏汤加减。中期贝4气阴两虚较为明显，以益气养阴之太子参、山药、黄芪、沙参、麦冬、玉竹、白芍、元参、女贞子等为主，佐以夏枯草、黛蛤散、生牡蛎等清肝平肝之品，并酌加小麦、莲肉，以养心阴，敛汗平悸。后期阴虚火旺渐平，而以脾虚痰阻为明显，常以参苓白朮散加减。颈肿和眼突多由肝火挟痰凝滞而成，故应以滋阴潜阳，软坚化痰之鳖甲、夏枯草、生牡蛎、浙贝母、旋复花、黛蛤散等主之，因其并非全系水土缺碘所致，故不宜必用海藻、昆布，海带等味。至于其它甲状腺瘤，则当以活血化瘀、软坚化痰、滋阴潜阳等法治之，海藻、昆布等自在当选之列。曾以此法治愈「甲状腺冷结节」患者，疗效尚称满意。
有些病症，经西医确诊，而中医典籍中虽无记载，但不见得古无此病，尚可从某些类似症状中得到启示。如「新生儿硬皮症」，与中医儿科「五硬」症相似。其病因病机，或为气血两虚，则血行不利，不能荣养肌肤四肢而致；或为土虚木旺，精血不能孺养筋脉肢节。一般来说，前者易治，后者较难。我常以王清任之补阳还五汤益气活血，以治前者，令气行血行，则肢节得养，后者则以健脾益气，祟土制木法，以四君、六君增删而治之。
许多病症，现代医学一时亦诊断不清，或虽有诊断，亦原因不明，或诊断虽明而疗效欠佳。均应根据中医理论，认真钻研，勤求各家学说和经验，亦可从中得到启发。如能不断积累经验，则对丰富中医宝库，不无帮助。曾治一「周期性发热」病者韩某，一九七六年十月开始发热，每月一次，持续3～5天，体温38．5～39．5。c。至一九七九年九月曾先后十次住院，经检查为免疫机能缺陷，虽中西治疗，未能根除，遂求诊于余。见其休瘦面黄，面目无神，手足及鼻尖易出汗，发热日哺为甚，脉祝取无力。诊为元气虚、阴火盛、营卫不足之证。以补中益气汤加首乌、鳖甲、牛膝为治，半月而愈。随访至今，未再复发。
互相勉励共同提高
以上仅就学习和从业的肤浅体会作一简介，我深感医道精深，不可浅尝辄止，而医者责任重大，临证不可不慎。诊病时务要审证求因，以究其本；论治时注意燮理阴阳，以平为期。而治病之遭，贵在因势利导，以疏通气血调理阴阳为要；用药之旨，要在切合病机，制方务求稳妥，用药宜轻灵活泼。古人云；「药贵精，精则专；忌庞杂，杂则无功。」治病不在药多量大，确为经验之谈。当然，对于急症重症，则又非大剂、峻剂不能取效。若能悉心临证，灵活变通，则可精益求精。我虽年已花甲，深感读书不多，经验更少，愿与同道及后学者共勉，互相学习，共同提高，咀求对中医事业作出微薄贡献。
我学习中的几点体会
武汉医学院第二附属医院中医科主任，副教授蒋洁尘
【作者简介】蒋洁尘(1918～)湖北汉阳县人。从事中医临床孝教学工作四十余年，着有《中医学基础》，并先后在京、汉、穗、鄂等医刊发表论文多篇。现正编写《景岳新方选》、《金匮选注》等论著。
余自幼多病，早有习医之念。予一九三三年春购得陆士谔编着之《医学南针》一套，继而又购读该篇后附记之必读医书；《内》、《难》、《伤寒》、《金匮》等。惟因无师指点，暗中揣摩，未能窥得门径。厥后，得阋恽铁樵之《伤寒论辑义按》及陆渊雷之《伤寒论今释》、《陆氏论医集》，以其浅而易懂，读后对此道渐次有所理解，而更坚定学习中医之信念，乃于翌年考入湖北国医专科学校就读。三年后卒业行医。于执业开始时，一度专攻《伤寒》、《金匮》，醉心「经方」，对宋，元、明、清诸流派的产生，认为是历史的倒退，曾蔑视温病学派，诋诽叶桂、吴瑭喜务轻灵，果子药不能愈大病。后临证渐多，方意识到此乃偏执。所谓「经方」、「时方」，同样来自实践，用之得当，均有良效。在这一阶段，同时又有一偏见，即认为中医优异之处，体现于临床实践，从而只重视临证有效之方药，除惟视仲景为「不二法门」外，相应地不甚留心理论，误认为这样是崇尚质朴，避免了空谈。遣后，受到师友之熏陶，结合临证之体会，乃渐次认识到理、法、方、药之间有不可分割的关系。方药脱离了理法的指导，就不成其为方药。撇开了理法专讲方药，名日重视，实际上并不成其为重视。从表面上看，这是重实践轻理论，实际上却是否定了实践和理论相互间的辩证关系。认识到此，余在尔后行医时，得以较好地处理理论学习和临证实践的关系，进而对法的重要作用及其正确运用有所体会。谨提供于此，以作刍荛之献。
「法」，是辨证论治之纽带
中医治病之特点为辨证论治，具体而言，不外理、法、方、药四个方面。所谓辨证或「理」，即是认识疾病，诊断疾病，所谓论治或「法、方、药」，即是解决疾病，治疗疾病。认证清晰，论理精当，诊断确切，是治疗疾病的前提，确定正确的治疗方针，选择恰当的治疗手段，是使疾病得以治愈的保证。因而理、法、方、药实为一密切相关的整体。这四个部分，何者重要，何者次要，看法容有不同，所谓见仁见智。依余浅见，论理正确是治病的前提，殊为重要，但需在辨证基础上，拟定治疗法则，选用适当方，药，方能完成辨证论治之全过程。其中「法」的拟定，既反映诊断，叉指导治疗，起到承上启下之纽带作用，更为重要。辨证论理，正如对敢我双方形势之分析，为制定战略战术之依据，治疗法则乃是根据敌我形势所制定的作战方针，具有战略意义；选方用药则是在战略思想指导下所运用之具体战术。古人谓「用药如用兵」，概括实为允恰。故方，药如离开治疗法则的指导，则等于无源之水，无本之木，只是药物的堆砌而失去方义。临床上正是依靠「法」这条主线，将理、法、方，药串成一有机的整体，而「法」在其中既独立存在，又渗透于理、方、药之中。这同武术家讲究手、眼、身、法、步，异曲同工，即「法」既为一端，又体现于手、眼、身、步之中。故严格讲来，理、法、方、药四端不可平列，其主线和关键是「法」。
中医自汉、唐以降，逐渐发展为各个流派，形成各流派的实质正是治疗法则，即以「法」分派。例如，金元四大家，不正是以「寒凉」、「攻下」、「补土」、「养阴」各派著称吗?降至后世，凡有成就、影响较大之中医名家，无不都是在治法上具有独到之处。如清·王清任擅长活血化瘀，居然以活血化瘀治疗五更泻、霍乱等等。又《医学广笔记》与《陆氏三世医验》均曾提及朱远斋其人。朱氏擅长攻下，有自制「润宇丸」一方，屡以攻下愈重证，深受丁长孺(《医学广笔记》之编者)及陆养愚之赞扬。总之，名家之出名，均表现在治法上有所专长，可漏代有其人，兹不一一列举。
因此，学习中医如不在掌握法则上狠下功夫，决难取得高深造诣。一部《内经》，方、药虽少，理、法独详，特别是有关治法这部分，散见于各篇章之中，扼要精当处，殊不少见，对具体选用方、药起着重要指导作用。故学习时必须深究《内经》中有关治疗法则之记载，即使是片言只语，也当精思冥悟。《伤寒论》条文共三百九十八条，前人称「伤寒三百九十八法」，提到「法」的高度来看待它，这是对《伤寒论》的推崇。陈藏器的「十剂」、程锺龄的「八法」，都能在《伤寒论》的方药中得到具体说明。
专门搜讨治疗方法的医籍，颇为少见。日本丹波元坚编着的《药治通义》编审精当，持论平正，收集得也很完备，值得参阅。
在「法」之指导下学习方剂(一)学习方剂，须明方义前人日：「方者法也。」意即方剂须体现法则，如方剂无法则作指导，势必形成「有药无方」。前人又日；「方者仿也。」意即方剂是可以仿制的，如只知生搬硬套，呆用成方，必将导致「有方无药」。「有药无方」与「有方无药」，其失相等，都是抽掉了法则的内容。临证拟方、用药，均宜根据病情需要，周不必囿于前人成方，更不得流于药物堆砌，要点在于依「法」选药组方。由是，临床上可以「有法无方(成方)」，万不可「有药无法」。有鉴于此，学习方剂不可限于背诵歌诀，杲记药昧，亦不只是了解其适应症，重要的是要理解其方义。尤怡的《医学读书记》中「补中益气汤、六味地黄丸台论」值得一提。论中谓：岵虚者，气多陷而不举，故补中益气汤用参、芪、术、草等甘温益气，而以升、柴辛平助以上升；阴虚者每每上而不下，故六味地黄丸多用熟地、萸肉、山药味厚体重者补阴益精，而以茯苓、泽泻、甘淡助之下降。气陷者多滞，陈皮之辛，所以利滞气，气浮者多热，丹皮之寒所以清浮热。然六味之有苓、泽，犹补中之有升、柴，补中之有陈皮，犹六昧之有丹皮也。其参、芪、归、术、甘草，犹地黄、菜萸、山药也。法虽不同而理可通也。」文中有分析，有比较，阐述堪称透辟简练，读之深受启迪，实属上乘方解。总之，学习方剂，必须细心精究，深明方义，方可举一反三，逐步提高。
(二)方剂配伍，相辅相成方剂之配伍，在治疗法则上须注意相互制约，相互为用，即所谓相反相成。如气虚宜补，气滞宜行。但治疗气虚，决不可单纯汇集补药；治疗气滞，亦不得一味行气破气。在一定情况下，应是于补或消之中，适当加以「反佐」，即补中有消，消中有补。
补中有消：即补气当佐以行气，如异功散用参、术等益气，配以陈皮即是。惟其如此，方能补而不滞。
消中有补：如四磨用乌药、槟，沉，佐以党参即是。这样才可以破气，防止耗气。
又方剂之配伍，尚须注意动静结合，升降相配，其理亦同。
然而，临床应用时亦非绝对如此，因在治疗法则上尚有「并行」与「独行」问题。《素问·标本病传论》指出：「谨察间甚，以意调之，闾者并行，甚者独行……」张景岳谓；「问者言病之浅，甚者言病之重也；病浅者，可以兼治，故日并行；病甚者，难以杂投，故日独行。」要之，并行或独行，应根据病情之标本缓急而定。如对急重的里实证，不骞徘徊瞻顾，务必纯任攻逐独行，不得杂以他法。因之，不能认为有了四磨，五磨可以弃置，同理，亦不得因已有黄龙汤，就不再需要大承气汤。凡此，都应在法则的指导下决定如何取舍，而法则又都有一定的适用范围，要引用得恰当，切合实际。
Since the founding of the People's Republic of China, with the implementation of the Party's Traditional Chinese Medicine (TCM) policies, most TCM practitioners have participated in national medical, teaching, and scientific research work, leading to frequent contact between Western medicine and TCM. However, before the academic integration of East and West was fully achieved, besides paying attention to strengthening unity, mutual learning, and complementing strengths with weaknesses, during clinical consultations, one must still base treatment on TCM theory, utilizing Four Diagnostic Methods (Wang, Wen, Wen, Qie - Inspection, Auscultation/Olfaction, Inquiry, Palpation) and Eight Principles (Yin-Yang, Exterior-Interior, Cold-Heat, Deficiency-Excess) for Syndrome Differentiation and Treatment (Bian Zheng Lun Zhi), in order to achieve efficacy. One must avoid being confined by Western disease names, which restricts the TCM syndrome differentiation thinking process, leaving one at a loss, or prescribing medication based solely on Western diagnoses without a solid basis for advancement or retreat. It is necessary to know that throughout its long development, Motherland Medicine has accumulated rich experience in understanding diseases, forming unique disease names. As early as in the *Nei Jing* (Inner Canon), there were disease names such as "Feng" (Wind), "Bi" (Obstruction/Painful Syndrome), "Wei" (Atrophy Syndrome), "Nue" (Malaria), "Xue Ku" (Blood Depletion), "Gu Zhang" (Drum Distension/Ascites), "Xiao" (Wasting-Thirst), and "Dan" (Heat Disease). Later, in the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), chapters were named after diseases, establishing a standard for combining disease identification with syndrome differentiation in clinical practice. Subsequent generations developed this further, forming a theoretical system that combines disease identification and syndrome differentiation. Xu Lingtai once stated, "The general category of all diseases is called 'Disease', but one disease must have several 'Syndromes'." Based on the teachings of former sages and personal experience, I believe that identifying the disease clarifies the category of the disease, while differentiating the syndrome seeks the cause of the disease. With the disease name as the guiding principle (Gang), symptoms are the details (Mu), and the cause is the root. Combining disease identification and syndrome differentiation allows the guiding principle to be raised and the details to be spread out. In essence, the four characters "Syndrome Differentiation and Treatment" already encompass issues related to disease identification, syndrome differentiation, seeking causes, administering treatment, principles, methods, formulas, and herbs. It is not that TCM lacks disease names, but compared to modern times, its uniformity is somewhat incomplete.
I once treated a woman who had prominent nodules in her breasts, with clear fluid occasionally oozing from the nipples, distension in both breasts, and fullness and pulling pain in the chest and hypochondrium, which were particularly severe during menstruation. Her pulse was deep and wiry (Chen Xian), and her tongue coating was thin and white. The Western diagnosis was "Accessory Breast Gland Hyperplasia". A physician considered it an inflammation caused by fire and prescribed a formula for clearing heat and detoxifying. After taking the medicine, she felt more chest tightness and discomfort, epigastric stuffiness, and poor appetite, so she sought my treatment. The nipple belongs to the Foot Jueyin Liver Meridian, and the breast belongs to the Foot Yangming Stomach Meridian. At the age of thirty-five (Five Sevens, referring to the decline of Yangming meridian qi in women according to the *Nei Jing*), combined with worry, overthinking, and anger, the Liver Qi lost its free flow, causing Liver Wood to insult Spleen Earth. This led to the tangling and stagnation of Qi, Blood, Phlegm, and Dampness, resulting in the disease known as "Ru Pi" (Breast Mass/Fibrocystic Breast Disease). The cause lies in Qi stagnation, and the syndrome belongs to Disharmony between Liver and Spleen. Following the principle of "Da Zhi Yu Mu" (Reaching/Strengthening the Depressed Liver), I employed a treatment method of soothing the Liver, strengthening the Spleen, resolving depression, and unblocking collaterals. I used Vinegar-processed Chai Hu (Bupleuri Radix), Qing Hao (Artemisiae Annuae Herba), Ju Ye (Citri Reticulatae Pericarpium Viride), Dan Pi (Moutan Cortex), Zhi Zi (Gardeniae Fructus), Dang Gui (Angelicae Sinensis Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Bo He (Menthae Haplocalycis Herba), Wang Bu Liu Xing (Vaccariae Semen), Lu Lu Tong (Liquidambaris Fructus), and Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata). After five consultations, she recovered within a month.
For some syndromes, although the Western and TCM disease names differ, their clinical manifestations may be similar. While reference can be made, the understandings differ, and they should not be conflated. "Thyroid Enlargement" is somewhat similar to TCM's "Ying Liu" (Goiter), but the situations vary. "Hyperthyroidism" (Jia Kang) is approximated by "Qi Ying" (Qi Goiter), often presenting as a pattern of Root Deficiency and Branch Excess. Root deficiency refers to Dual Deficiency of Qi and Yin; branch excess refers to Stomach Heat and Liver Depression, or transformation into Fire generating Wind. In the initial stage, it is appropriate to Clear Liver and Drain Heat, assisted by Nourishing Yin and Clearing Stomach Heat, using modified Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver) or Dan Zhi Xiao Yao San (Moutan and Gardenia Powder for Free Wanderer), or酌情 (discretionarily) employing modified Bai Hu Tang (White Tiger Decoction) or Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction). In the middle stage, Dual Deficiency of Qi and Yin becomes more obvious. The main ingredients are Qi-tonifying and Yin-nourishing herbs such as Tai Zi Shen (Pseudostellariae Radix), Shan Yao (Dioscoreae Rhizoma), Huang Qi (Astragali Radix), Sha Shen (Glehniae Radix), Mai Dong (Ophiopogonis Radix), Yu Zhu (Polygonati Odorati Rhizoma), Bai Shao (Paeoniae Radix Alba), Yuan Shen (Scrophulariae Radix), and Nu Zhen Zi (Ligustri Lucidi Fructus), assisted by Xia Ku Cao (Prunellae Spica), Dai Ge San (Indigo and Clam Shell Powder), and Sheng Mu Li (Ostreae Concha) to Clear and Pacify the Liver. Wheat and Lotus Seeds (Lian Rou) may be added to Nourish Heart Yin, stop sweating, and calm palpitations. In the late stage, when Yin Deficiency with Empty Fire gradually subsides, Spleen Deficiency with Phlegm Obstruction becomes prominent. Modified Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) is often used. Neck swelling and exophthalmos are often caused by Liver Fire carrying Phlegm to stagnate. Therefore, herbs such as Bie Jia (Testudinis Carapax et Plastrum), Xia Ku Cao, Sheng Mu Li, Zhe Bei Mu (Fritillariae Thunbergii Bulbus), Xuan Fu Hua (Inulae Flos), and Dai Ge San should be used to Nourish Yin, Subdue Yang, Soften Hardness, and Resolve Phlegm. Since these are not entirely caused by iodine deficiency in soil and water, herbs like Hai Zao (Sargassum), Kun Bu (Laminariae Thallus), and Hai Dai (Sargassum pallidum) should not be mandatory. For other thyroid tumors, treatments should focus on Invigorating Blood and Resolving Stasis, Softening Hardness and Resolving Phlegm, and Nourishing Yin while Subduing Yang. Hai Zao and Kun Bu are naturally among the selected choices. I once cured a patient with "Cold Nodule of Thyroid" using this method, with satisfactory results.
Some diseases, although diagnosed by Western medicine, may not be recorded in TCM classics, but this does not mean they did not exist in ancient times. Inspiration can still be drawn from similar symptoms. For example, "Neonatal Scleredema" is similar to the TCM pediatric condition "Wu Ying" (Five Stiffnesses). Its etiology and pathogenesis may be due to Dual Deficiency of Qi and Blood, leading to poor blood circulation and failure to nourish the skin, muscles, limbs, and extremities; or it may be due to Spleen Deficiency with Liver Excess, where Essence and Blood fail to nourish the sinews, vessels, joints, and limbs. Generally speaking, the former is easier to treat, while the latter is more difficult. I often use Wang Qingren's Bu Yang Huan Wu Tang (Decoction to Tonify Yang and Restore Five Functions) to tonify Qi and Invigorate Blood to treat the former, allowing Qi to move Blood so that limbs and joints are nourished. For the latter, I use the method of Strengthening Spleen and Tonifying Qi, and Supporting Earth to Control Wood, treating it with modified Si Jun Zi Tang (Four Gentlemen Decoction) or Liu Jun Zi Tang (Six Gentlemen Decoction).
Many diseases are currently unclear in modern medical diagnosis, or even if diagnosed, the cause remains unknown, or the diagnosis is clear but the therapeutic effect is poor. All should be carefully studied based on TCM theory, diligently seeking theories and experiences from various schools, which can also provide inspiration. If experience can be continuously accumulated, it will undoubtedly help enrich the treasure house of TCM. I once treated a patient named Han suffering from "Periodic Fever". Starting in October 1976, he had fevers once a month, lasting 3-5 days, with temperatures ranging from 38.5°C to 39.5°C. By September 1979, he had been hospitalized ten times. Examination revealed immune function deficiency. Despite both Western and TCM treatments, the condition could not be eradicated, so he sought my consultation. He appeared emaciated with a sallow complexion, dull eyes and face, and easy sweating on hands, feet, and nose tip. The fever was worse in the evening (Ri Bu). His pulse was weak upon palpation. I diagnosed this as a syndrome of Deficient Yuan Qi (Original Qi), Prosperous Yin Fire, and Insufficient Ying and Wei (Nutritive and Defensive Qi). I treated him with modified Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) adding Shou Wu (Polygoni Multiflori Radix), Bie Jia, and Niu Xi (Achyranthis Bidentatae Radix). He recovered in half a month. Follow-up to date shows no recurrence.
Mutual Encouragement and Joint Improvement
The above is a brief introduction to my superficial experiences in learning and practice. I deeply feel that the medical way is profound and cannot be stopped after a shallow taste. The responsibility of a doctor is great, and one must be cautious in clinical practice. When diagnosing, one must examine the syndrome to seek the cause and investigate the root; when discussing treatment, one must pay attention to balancing Yin and Yang, aiming for equilibrium. The key to treating disease lies in facilitating the natural trend, with the priority being to unblock Qi and Blood and regulate Yin and Yang. The purpose of medication lies in conforming to the pathogenesis, formulating prescriptions steadily, and using drugs lightly and flexibly. The ancients said: "Medicine values precision; precision leads to specialization. Avoid complexity; complexity yields no merit." Treating disease does not depend on the quantity or dosage of medicines; this is indeed a statement of experience. Of course, for acute and severe conditions, large doses and potent agents are required to achieve efficacy. If one practices clinically with care and flexibility, one can strive for perfection. Although I am now in my sixties, I feel I have read little and have even less experience. I wish to encourage myself with colleagues and younger learners, to learn from each other, improve together, and strive to make a modest contribution to the cause of TCM.
(Organized by Wang Pengyu, Yao Naili, Lu Xisu)
Several Insights from My Learning
Jiang Jiechen, Director of the TCM Department, Associate Professor, Second Affiliated Hospital of Wuhan Medical College
[Author Profile] Jiang Jiechen (1918–) from Hanyang County, Hubei Province. Engaged in TCM clinical and teaching work for over forty years. Authored *Fundamentals of Traditional Chinese Medicine* and published numerous papers in medical journals in Beijing, Wuhan, Guangzhou, and Ezhou. Currently compiling *Selected New Formulas of Jing Yue* and *Annotations on Jin Gui*.
I was prone to illness since childhood and had the idea of studying medicine early on. In the spring of 1933, I purchased a set of *Yi Xue Nan Zhen* (Medical South Needle) compiled by Lu Shie. Subsequently, I purchased and read the essential medical books listed in its appendix: *Nei* (*Huang Di Nei Jing*), *Nan* (*Nan Jing*), *Shang Han* (*Shang Han Lun*), and *Jin Gui* (*Jin Gui Yao Lue*). However, without a teacher's guidance, I pondered in secret and failed to find the entry point. Later, I read Yun Tieqiao's *Shang Han Lun Ji Yi An* and Lu Yuanlei's *Shang Han Lun Jin Shi* and *Lu Shi Lun Yi Ji*. Because they were shallow and easy to understand, I gradually gained some understanding of this path after reading them, and my belief in studying TCM became firmer. Thus, the following year, I entered the Hubei National Medical Specialty School to study. Three years later, I graduated and began practicing. At the beginning of my practice, I once specialized in *Shang Han* and *Jin Gui*, becoming obsessed with "Jing Fang" (Classical Formulas). I considered the emergence of various schools in the Song, Yuan, Ming, and Qing dynasties as a historical regression. I once despised the Warm Disease school, criticizing Ye Gui and Wu Tang for preferring light and delicate approaches, believing that such drugs could not cure serious illnesses. Later, with increasing clinical cases, I realized this was a prejudice. So-called "Jing Fang" and "Shi Fang" (Contemporary Formulas) both come from practice; when used appropriately, both have good effects. At this stage, I had another prejudice: I believed that the superiority of TCM was reflected in clinical practice, so I only valued effective formulas and herbs in clinical practice. Except for regarding Zhang Zhongjing as the "only true method," I correspondingly paid little attention to theory, mistakenly thinking that this was advocating simplicity and avoiding empty talk. Afterwards, influenced by teachers and friends, and combined with clinical experience, I gradually realized the inseparable relationship between Principle (Li), Method (Fa), Formula (Fang), and Herb (Yao). Formulas and herbs, detached from the guidance of principles and methods, cease to be valid formulas and herbs. Ignoring principles and methods to focus solely on formulas and herbs, nominally called valuing them, is actually not valuing them. On the surface, this seems to prioritize practice over theory, but in reality, it denies the dialectical relationship between practice and theory. Recognizing this, I was able to better handle the relationship between theoretical study and clinical practice in my subsequent medical career, and further gain insight into the important role of "Method" and its correct application. I offer this here as a humble contribution.
"Method" is the Link in Syndrome Differentiation and Treatment
The characteristic of TCM treatment is Syndrome Differentiation and Treatment. Specifically, it involves four aspects: Principle, Method, Formula, and Herb. So-called Syndrome Differentiation or "Principle" refers to recognizing and diagnosing the disease. So-called Treatment Discussion or "Method, Formula, Herb" refers to solving and treating the disease. Clear recognition, precise reasoning, and accurate diagnosis are the prerequisites for treating the disease. Determining the correct treatment policy and selecting appropriate treatment means are the guarantees for curing the disease. Therefore, Principle, Method, Formula, and Herb form a closely related whole. Regarding which of these four parts is important and which is secondary, views may differ, as the saying goes, "Beauty is in the eye of the beholder." In my humble opinion, correct reasoning is the prerequisite for treating disease and is extremely important. However, it is necessary to formulate treatment methods based on syndrome differentiation and select appropriate formulas and herbs to complete the entire process of syndrome differentiation and treatment. Among them, the formulation of "Method" reflects the diagnosis and guides treatment, playing a crucial linking role, making it even more important. Differentiating syndrome and reasoning is like analyzing the situation between ourselves and the enemy, serving as the basis for formulating strategy and tactics. The treatment method is the combat policy formulated based on the situation, possessing strategic significance; selecting formulas and herbs is the specific tactic applied under the guidance of strategic thought. The ancients said, "Using medicine is like using troops," which is a very apt summary. Therefore, if formulas and herbs leave the guidance of treatment methods, they are like water without a source and trees without roots, merely a pile of drugs losing their formula meaning. Clinically, it is precisely by relying on this main thread of "Method" that Principle, Method, Formula, and Herb are strung into an organic whole. "Method" exists independently within it and permeates Principle, Formula, and Herb. This is analogous to martial artists emphasizing Hand, Eye, Body, Method, and Step; "Method" is both one end and embodied in the others. Strictly speaking, the four ends of Principle, Method, Formula, and Herb cannot be listed equally; the main thread and key is "Method."
Since the Han and Tang dynasties, TCM has gradually developed into various schools. The essence of forming these schools is precisely the treatment method, i.e., dividing schools by "Method." For example, are not the Four Great Masters of the Jin and Yuan periods famous for their respective schools of "Cold-Cooling," "Purgation," "Earth-Supporting," and "Yin-Nourishing"? Descending to later generations, all TCM masters with achievements and significant influence possessed unique insights in treatment methods. For instance, Wang Qingren of the Qing Dynasty excelled in Invigorating Blood and Resolving Stasis, surprisingly using this method to treat Wugeng Xie (Morning Diarrhea) and Huoluan (Cholera-like disease), etc. Both *Yi Xue Guang Bi Ji* and *Lu Shi Sanshi Yi Yan* mentioned a person named Zhu Yuanzhai. Zhu excelled in Purgation and had a self-made formula called "Run Zi Wan" (Moistening Character Pill). He frequently cured severe conditions using purgation, earning high praise from Ding Changru (editor of *Yi Xue Guang Bi Ji*) and Lu Yangyu. In short, the fame of masters is manifested in their specialization in treatment methods. There have been such people throughout history, so I will not list them one by one.
Therefore, if one does not put in hard effort to master methods while studying TCM, it is impossible to achieve high attainments. In the *Nei Jing*, although there are few formulas and herbs, the principles and methods are detailed. Especially the part concerning treatment methods, scattered across various chapters, contains many concise and appropriate points that play an important guiding role in the specific selection of formulas and herbs. Therefore, when studying, one must deeply explore the records of treatment methods in the *Nei Jing*. Even fragmentary words should be carefully contemplated and understood. The *Shang Han Lun* has 398 clauses. Former people called it "Three Hundred Ninety-Eight Methods of Shang Han," elevating it to the height of "Methods." This is a tribute to the *Shang Han Lun*. Chen Cangqi's "Ten Categories of Medicines" and Cheng Zhongling's "Eight Methods" can all be specifically explained in the formulas and herbs of the *Shang Han Lun.*
Medical books specifically searching for treatment methods are quite rare. The *Yao Zhi Tong Yi* (Comprehensive Meaning of Drug Treatment) compiled by the Japanese scholar Tanbo Yuanjian is carefully edited, holds balanced arguments, and is comprehensively collected, worthy of reference.
Learning Formulas under the Guidance of "Method"
(1) Learning Formulas Requires Understanding Formula Meaning. Former people said: "Formula is Method." This means formulas must embody methods. If a formula lacks method guidance, it inevitably forms "Herbs without Formula." Former people also said: "Formula is Imitation." This means formulas can be imitated. If one only knows rigid copying and mechanically uses existing formulas, it will inevitably lead to "Formula without Herbs." The errors of "Herbs without Formula" and "Formula without Herbs" are equal; both strip away the content of the method. When prescribing and using herbs clinically, one should suit the needs of the condition, not necessarily be confined to previous existing formulas, and certainly not degenerate into a pile of drugs. The key point is to select herbs and compose formulas according to "Method." Therefore, clinically, one can have "Method without (Existing) Formula," but absolutely must not have "Herbs without Method." In view of this, learning formulas should not be limited to reciting songs or memorizing herb flavors, nor is it just about understanding indications. The important thing is to understand the formula meaning. The "Combined Discussion on Bu Zhong Yi Qi Tang and Liu Wei Di Huang Wan" in You Yi's *Yi Xue Du Shu Ji* is worth mentioning. The discussion states: "Those with Qi Deficiency often have Qi sinking and failing to rise, so Bu Zhong Yi Qi Tang uses Ren (Ginseng), Qi (Astragalus), Zhu (Atractylodes), and Cao (Licorice) to tonify Qi with sweet-warm properties, while using Sheng (Bupleurum) and Chai (Bupleurum) with pungent-flat properties to assist in rising. Those with Yin Deficiency often float upward and do not descend, so Liu Wei Di Huang Wan mostly uses Shu Di (Rehmannia), Yu Rou (Cornus), and Shan Yao (Dioscorea) with thick flavors and heavy weight to nourish Yin and benefit Essence, while using Fu Ling (Poria) and Ze Xie (Alisma) with sweet-light properties to assist in descending. Those with sinking Qi often have stagnation; the pungency of Chen Pi (Tangerine Peel) benefits stagnant Qi. Those with floating Qi often have Heat; the coldness of Dan Pi (Moutan) clears floating Heat. However, the presence of Fu Ling and Ze Xie in Liu Wei is like the presence of Sheng and Chai in Bu Zhong; the presence of Chen Pi in Bu Zhong is like the presence of Dan Pi in Liu Wei. Their Ren, Qi, Gui, Zhu, and Gan Cao are like Di Huang, Yu Rou, and Shan Yao. Although the methods differ, the principles can be connected." The text contains analysis and comparison, and the exposition is thorough and concise, providing great enlightenment upon reading. It is truly an excellent formula explanation. In short, learning formulas requires careful and profound study, deeply understanding formula meaning, so as to draw inferences and gradually improve.
(2) Formula Compatibility, Complementing Each Other. Formula compatibility must pay attention to mutual restriction and mutual utility in treatment methods, known as "Opposite yet Complementary." For example, Qi Deficiency should be tonified, and Qi Stagnation should be moved. However, treating Qi Deficiency should never simply gather tonifying herbs; treating Qi Stagnation should never blindly use Qi-moving or Qi-breaking herbs. Under certain circumstances, one should appropriately add "Counter-Assistance" (Fan Zuo) within tonification or reduction, i.e., tonification containing reduction, and reduction containing tonification.
Tonification containing Reduction: This means when tonifying Qi, one should assist with Qi-moving herbs. For example, Yi Gong San uses Ren and Zhu to tonify Qi, paired with Chen Pi. Only in this way can tonification prevent stagnation.
Reduction containing Tonification: For example, Si Mo Yin uses Wu Yao, Bing Lang, and Chen Xiang, assisted by Dang Shen. This allows breaking Qi while preventing consumption of Qi.
Furthermore, formula compatibility must also pay attention to combining Movement and Stillness, and matching Ascending and Descending, the principle being the same.
However, clinical application is not absolute in this regard, because there are also issues of "Concurrent Action" and "Single Action" in treatment methods. The *Su Wen: Biao Ben Bing Zhuan Lun* states: "Carefully observe the mildness and severity, adjust according to intent. For mild cases, act concurrently; for severe cases, act singly..." Zhang Jingyue said: "'Mild' refers to shallow disease, 'Severe' refers to heavy disease. For shallow diseases, multiple treatments can be combined, hence 'Concurrent Action'; for severe diseases, mixed administration is difficult, hence 'Single Action.'" In short, concurrent or single action should be determined based on the root and branch, urgency, and slackness of the condition. For example, in acute and severe interior excess patterns, one must not hesitate, but must purely rely on purgation acting singly, without mixing other methods. Therefore, one cannot think that having Si Mo or Wu Mo allows discarding them; similarly, one must not think that having Huang Long Tang eliminates the need for Da Cheng Qi Tang. All of these should be decided on how to choose and discard under the guidance of methods, and methods all have certain scopes of application. They must be cited appropriately and practically.